TWiN (The Week in Nephrology) 29 August 2016

Starting this week with a "Blast from the past. " review.  Joel tweeted this article from Cleveland Clinic Journal of Medicine on " Preventing and treating orthostatic hypotension " The authors give a simple mnemonic on various measures one can take to control orthostatic hypotension. H/T @kidney_boy

In a study published in JAMA recently , a group of investigators conducted a substudy of the Chinese Stroke Primary Prevention Trial. Here they studied the effect of Folic acid supplementation in Chinese adults with HTN, on CKD progression. Compared to Enalapril alone, Enalapril 10 mg + FOLIC ACID 0.8 mg PO daily had a 21% reduction in CKD progression in patients with mild to moderate CKD.

Steroids frequently form a part of the therapeutic regimen for kidney transplant patients, several studies have investigated the effect of steroid avoidance, withdrawal on transplant outcomes. Cochrane first published a review in 2009 and now presents an update on the same topic with analysis of 48 studies.  No difference in survival, graft loss, infections or malignancyin steroid maintenance vs steroid avoidance/withdrawal. And there was continued evidence of more acute rejection in steroid withdrawal arm.

What are the long term outcomes in patients with AKI requiring RRT in the ICU. A paper published in Critical Care addresses this question. AKI-RRT occured in 5.5% patients and had hospital mortality of 59% and 3 year mortality of72%. Complete renal recovery occured in 48% but the rest had incomplete or no recovery - mandating a Nephrology follow up.

The current issue of Transplantation has two interesting reviews -

  • IgA Nephropathy is the commonest GN to need a KTx. This review discusses the epidemiology, mechanism and management of Recurrent IgAN in kidney transplant.

  • Tuberculosis is an important consideration in transplant recipients, especially in the developing countries. This review discusses the Prevention and Management of Tuberculosis in solid organ transplants.

Mesoamerican nephropathy (CKDu) comes to focus again. In an article in AJKD the CKDu hotspotin Nicaragua showed hyperuricemia as an association in CKDu men.

And lastly a review on extended dialysis - how much we know and how much we donot about the dialysis adequacy and the role of increasing dialysis prescriptions. This is from Seminars in Dialysis.


-- Nikhil Shah (@dr_nikhilshah)